Establishment of prediction scale for early hematoma expansion after intracerebral hemorrhage and its preliminary effectiveness evaluation

Abstract

Objective \nTo establish a prediction scale of early hematoma expansion (HE) after intracerebral hemorrhage (ICH) and evaluate its prediction effectiveness. \n \n \nMethods \nA retrospective analysis of clinical features of 317 ICH patients, admitted to our hospital from January 2016 to May 2018, was performed. Risk factors for early HE after ICH were obtained by multivariate Logistic regression analysis, and independent risk factors with P<0.05 were used to establish the prediction scale; the assigned scores for each item were derived by parameter estimates (β coefficients) and increased proportionately to the nearest integer. Receiver operating characteristic (ROC) curve was used to evaluate the discriminating ability of the prediction scale, Hosmer-Lemeshow goodness of fit test and calibration curve were used to evaluate its accuracy, and the decision curve analysis was used to evaluate its clinical practicability. Finally, the established prediction scale was applied to this group of patients for verification. \n \n \nResults \nHistory of anticoagulants, ultra-early hematoma growth (uHG)≥2.7 mL/h, Glasgow coma scale (GCS) scores≤8, and non-enhanced CT (NCCT) signs (island sign, black hole sign, blend sign, niveau formation) existing one or several kinds were independent risk factors for early HE after ICH (P<0.05); the assigned values of uHG≥2.7 mL/h, GCS scores≤8, NCCT signs (island sign, black hole sign, blend sign, niveau formation) existing one or several kinds, and history of anticoagulants were 2.5, 2.0, 2.0, and 4.5, respectively; the total prediction scale scores were 0-11. The area under ROC curve was 0.854 (95%CI: 0.803-0.904, P=0.000), and the calibration was high (χ2=3.323, P=0.344); decision curve analysis showed high net benefit and wide range of optional threshold probability of the scale. After validating in the development cohort, the sensitivity, specificity and accuracy of the high-risk group (prediction scale≥4.5) were 0.77, 0.85 and 0.83, respectively. \n \n \nConclusion \nThe prediction scale for early HE after ICH established may provide some references and help for accurate identifying of high-risk individuals of early HE, guiding clinical treatments, and serving clinical trials. \n \n \nKey words: \nIntracerebral hemorrhage;\xa0Early hematoma expansion;\xa0Prediction scale;\xa0Non-enhanced CT sign